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Pulmonary Flashcards

1
Q

Classification of Asthma Severity in Adults (12 years +)

Frequency of symptoms

A

2 days or less/week = Intermittent

> 2 days/week but not daily = Mild Persistent

Daily = Moderate Persistent

Throughout the day = Severe Persistent

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2
Q

Classification of Asthma Severity in Adults (12 years +)

Nighttime awakening

A

2x or less/month = Intermittent

3-4x/month = Mild Persistent

More than once weekly but not nightly = Moderate Persistent

Often 7x/week = Severe Persistent

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3
Q

Classification of Asthma Severity in Adults (12 years +)

SABA use for symptom control

A

2 days or less/week = Intermittent

> 2 days/week but not daily = Mild Persistent

Daily = Moderate Persistent

Several times a day = Severe Persistent

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4
Q

Classification of Asthma Severity in Adults (12 years +)

Interference with activity

A

None = Intermittent

Minor limitation = Mild Persistent

Some limitations = Moderate Persistent

Extremely limited = Severe Persistent

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5
Q

Classification of Asthma Severity in Adults (12 years +)

FEV1 (% of normal)

A

> 80% (normal) = Intermittent

> 80% (normal) = Mild Persistent

> 60% to < 80% = Moderate Persistent

< 60% = Severe Persistent

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6
Q

Classification of Asthma Severity in Adults (12 years +)

Exacerbations requiring oral steroids

A

0-1/year = Intermittent

2 or more/year = Mild Persistent

2 or more/year = Moderate Persistent

2 or more/year = Severe Persistent

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7
Q

What is the recommended step for initiating treatment in asthma patients?

A

Intermittent = Step 1

Mild Persistent = Step 2

Moderate Persistent = Step 3 and consider short course of oral steroids

Severe Persistent = Step 4 or 5 and consider short course of oral steroids

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8
Q

When assessing asthma control, when would a patient be considered well controlled?

A

Symptoms = 2 days or less/week

Nighttime awakenings = 2x or less/month

Interference w/ normal activity = None

SABA use for symptom control = 2 days or less/week

Exacerbations requiring oral steroids = 0-1x/year

Recommended Treatment:
-Maintain current step
-Regular follow-up every 1-6 months
-Consider step-down if well control for 3+ months

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9
Q

When assessing asthma control, when would a patient be considered not well controlled?

A

Symptoms = > 2 days/week

Nighttime awakenings = 1-3x/week

Interference w/ normal activity = Some limitations

SABA use for symptom control = > 2 days/week

Exacerbations requiring oral steroids = 2x or more/year

Recommended Treatment:
-Step up one step
-Re-evaluate in 2-6 weeks

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10
Q

When assessing asthma control, when would a patient be considered very poorly controlled?

A

Symptoms = Throughout the day

Nighttime awakenings = 4x or more/week

Interference w/ normal activity = Extremely limited

SABA use for symptom control = Several times a day

Exacerbations requiring oral steroids = 2x or more/year

Recommended Treatment:
-Consider short course of oral steroids
-Step-up one-to-two steps
-Re-evaluate in 2 weeks

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11
Q

What are the instructions if using ICS/formoterol SMART inhaler therapy?

A

1-2 puffs (4.5 mcg of formoterol/puff) every 4 hours as needed

Max of 12 puffs/day

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12
Q

What is the recommended inhaler therapy for Step 1 in asthma?

A

NHLBI = No controller needed

2020 Focused Updates = SABA PRN

GINA
-Track 1: low-dose ICS/formoterol PRN
-Track 2: low-dose ICS when SABA is taken

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13
Q

Per NHLBI asthma treatment recommendations, what inhaler therapy is recommended for all steps?

A

SABA PRN

*if patients using ICS/formoterol as controller in Steps 3/4, can consider using PRN for quick relief

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14
Q

What is the recommended inhaler therapy for Step 2 in asthma?

A

NHLBI = Low-dose ICS or PRN concomitant ICS + SABA

2020 Focused Updates = Low-dose ICS or PRN concomitant ICS + SABA

GINA
-Track 1: low-dose ICS/formoterol PRN
-Track 2: low-dose ICS

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15
Q

What is the recommended inhaler therapy for Step 3 in asthma?

A

NHLBI = Low-dose ICS/formoterol

2020 Focused Updates = Low-dose ICS/formoterol
*Alternate: Medium-dose ICS

GINA
-Track 1: low-dose ICS/formoterol
-Track 2: low-dose ICS/LABA

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16
Q

What is the recommended inhaler therapy for Step 4 in asthma?

A

NHLBI = Medium-dose ICS/formoterol

2020 Focused Updates = Medium-dose ICS/formoterol

GINA
-Track 1: medium-dose ICS/formoterol
-Track 2: medium-to-high-dose ICS/LABA

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17
Q

What is the recommended inhaler therapy for Step 5 in asthma?

A

NHLBI = Medium-to-high-dose ICS/LABA + LAMA; consider biologics for patients with allergic asthma

2020 Focused Updates = Medium-to-high-dose ICS/LABA + LAMA; consider biologics for patients with allergic asthma

GINA
-Track 1: add on LAMA; consider high-dose ICS/formoterol
-Track 2: add on LAMA; consider high-dose ICS/LAMA

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18
Q

What is the recommended inhaler therapy for Step 6 in asthma?

A

NHLBI = High-dose ICS/LABA plus systemic corticosteroids; consider biologics for patients with allergic asthma

2020 Focused Updates = High-dose ICS/LABA plus systemic corticosteroids; consider biologics for patients with allergic asthma

GINA = nothing mentioned

19
Q

What black box warning does Montelukast carry?

A

Neuropsychiatric symptoms

20
Q

What are side effects of LAMAs?

A

-Dry mouth
-Blurred vision
-Tachycardia
-Palpitations
-Bitter or sweet taste

21
Q

What are side effects of LABAs?

A

-Tremors
-Tachycardia

22
Q

What are side effects of ICSs?

A

-Oral candidiasis
-Hoarseness

23
Q

How is COPD diagnosed?

A

FEV1/FVC < 0.7

24
Q

What is GOLD grade 1?

A

Mild; FEV1 80% or greater of predicted

25
What is GOLD grade 2?
Moderate; FEV1 50% or greater and less than 80% of predicted
26
What is GOLD grade 3?
Severe; FEV1 30% of greater and less than 50% of predicted
27
What is GOLD grade 4?
Very Severe; FEV1 < 30% of predicted
28
Which COPD group would the following fit into? -1 or less exacerbations/year NOT leading to hospitalization -mMRC 0-1 OR CAT < 10
A
29
Which COPD group would the following fit into? -1 or less exacerbations/year NOT leading to hospitalization -mMRC 2 or more OR CAT 10 or more
B
30
Which COPD group would the following fit into? -2 or more exacerbations/year OR 1+ w/ hospitalization -Fewer or more symptoms
E
31
What is the recommended initial treatment for patients with COPD group A?
Bronchodilator
32
What is the recommended initial treatment for patients with COPD group B?
LABA + LAMA
33
What is the recommended initial treatment for patients with COPD group E?
LABA + LAMA *Consider LABA + LAMA + ICS if eos > 300 and/or history of or concurrent asthma
34
How should inhaler therapy be adjusted for patients who predominantly experience dyspnea per GOLD guidelines?
LABA or LAMA -> LABA + LAMA -Consider switching inhaler device -Implement or escalate non-pharm treatment -Investigate (and treat) other causes of dyspnea
35
How should inhaler therapy be adjusted for patients who predominantly experience exacerbations per GOLD guidelines?
LABA or LAMA -> LABA + LAMA + ICS (if eos 300+) -> Roflumilast (FEV1 < 50% and chronic bronchitis) or azithromycin LABA or LAMA -> LABA + LAMA (if eos < 300) -> LABA + LAMA + ICS (if eos 100+)
36
What are side effects of roflumilast?
-Diarrhea -Weight loss/decreased appetite -Insomnia -Dizziness -Back pain
37
What is a COPD exacerbation?
Acute worsening of patient's baseline respiratory symptoms that is worse than normal day-to-day variation -Dyspnea and/or cough and/or an increase in quantity or purulence of sputum
38
What is the preferred initial treatment of a COPD exacerbation?
Inhaled SABA with/without SAMA AND Prednisone 40 mg for 5-7 days
39
When are antibiotics indicated during a COPD exacerbation?
Presence of 2 of the 3 cardinal symptoms: -Increased dyspnea -Increased sputum volume -Increased sputum purulence*
40
What antibiotics are appropriate for a COPD exacerbation?
Uncomplicated: -Azithromycin, clarithromycin -Doxycycline -Amoxicillin +/- clavulanate Complicated (comorbid diseases, severe COPD, more than 3 exacerbations/year, antibiotic use in past 3 months) -Amoxicillin/clavulanate -Levofloxacin -Moxifloxacin
41
How long should antibiotics be used for a COPD exacerbation?
5-7 days
42
What are the "5 A's" of tobacco cessation?
-Ask -Assess (current use, motivations, history) -Advise -Assist (offer and connect to treatment) -Arrange (follow-up)
43
What does STAR refer to when helping patients design a quit plan?
-Set a quit date (within 2 weeks is ideal) -Tell family, friends, coworkers -Anticipate challenges (including withdrawal) -Remove tobacco products/paraphernalia from environment
44
Per ACC guidelines, what is the recommended first-line therapy for tobacco cessation?
Combination NRT therapy OR Varenicline monotherapy

BCACP (20 decks)

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